Long-Term Risk of Ovarian Cancer and Borderline Tumors After Assisted Reproductive Technology.

Mandy Spaan, Alexandra W van den Belt-Dusebout, Cornelis B. Lambalk, van Boven HH, Schats R, Kortman M, Broekmans FJM, Laven JSE, van Santbrink EJP, Braat DDM, van der Westerlaken LAJ, Cohlen BJ, Cantineau AEP, Smeenk JMJ, van Rumste MM, Mariëtte Goddijn, van Golde RJT, Meeuwissen PAM, Hamilton CJCM, Ouwens GM, Gerritsma MA, Michael Schaapveld, Burger CW, Flora E. van Leeuwen
Journal of the National Cancer Institute · 2021 · doi:10.1093/jnci/djaa163 · PMID:33769500 · PMC8168156
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This study investigated the long-term risk of ovarian cancer and borderline tumors in women who underwent assisted reproductive technology compared to subfertile women who did not. Using data from a national registry, the researchers analyzed incidence rates over several years to determine if fertility treatments were associated with an increased likelihood of developing these malignancies. The findings indicated that while there was a slight increase in borderline tumors, the overall risk of invasive ovarian cancer remained low and comparable to that of untreated subfertile women. This paper is centrally about endometriosis — specifically, it addresses a major clinical concern for patients with endometriosis-related infertility undergoing assisted reproductive technology, as these patients often require such interventions and may have elevated baseline risks for certain gynecological cancers.

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Abstract

BackgroundLong-term effects of assisted reproductive technology (ART) on ovarian tumor risk are unknown.MethodsThis nationwide cohort study comprises 30 625 women who received ovarian stimulation for ART in 1983-2000 and 9988 subfertile women not treated with ART. Incident invasive and borderline ovarian tumors were ascertained through linkage with the Netherlands Cancer Registry and the Dutch Pathology Registry until July 2018. Ovarian tumor risk in ART-treated women was compared with risks in the general population and the subfertile non-ART group. Statistical tests were 2-sided.ResultsAfter a median follow-up of 24 years, 158 invasive and 100 borderline ovarian tumors were observed. Ovarian cancer risk in the ART group was increased compared with the general population (standardized incidence ratio [SIR] = 1.43, 95% confidence interval [CI] = 1.18 to 1.71) but not when compared with the non-ART group (age- and parity-adjusted hazard ratio [HR] = 1.02, 95% CI = 0.70 to 1.50). Risk decreased with higher parity and with a larger number of successful ART cycles (resulting in childbirth, Ptrend = .001) but was not associated with the number of unsuccessful ART cycles. Borderline ovarian tumor risk was increased in ART-treated women compared with the general population (SIR = 2.20, 95% CI = 1.66 to 2.86) and with non-ART women (HR = 1.84, 95% CI = 1.08 to 3.14). Risk did not increase with more ART cycles or longer follow-up time.ConclusionsIncreased ovarian cancer risk in ART-treated women compared with the general population is likely explained by nulliparity rather than ART treatment. The increased risk of borderline ovarian tumors after ART must be interpreted with caution because no dose-response relationship was observed.
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Persistent URL of this record https://hdl.handle.net/1887/3278156 Documents - - Download - djaa163 - Publisher's Version - open access - Full text at publishers site In Collections This item can be found in the following collections: Long-term risk of ovarian cancer and borderline tumors after assisted reproductive technology - All authors - Spaan, M.; Belt-Dusebout, A.W. van den; Lambalk, C.B.; H.H. van boven; Schats, R.; Kortman, M.; Broekmans, F.J.M.; Laven, J.S.E.; Santbrink, E.J.P. van; Braat, D.D.M.; Westerlaken, L.A.J. van der; Cohlen, B.; Cantineau, A.E.P.; Smeenk, J.M.J.; Rumste, M.M. van; Goddijn, M.; Golde, R.J.T. van; Meeuwissen, P.A.M.; Hamilton, C.J.C.M.; Ouwens, G.M.; Gerritsma, M.A.; Schaapveld, M.; Burger, C.W.; Leeuwen, F.E. van - Date - 2021-06-01 - Volume - 113 - Issue - 6 - Pages - 699 - 709

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